Provider Demographics
NPI:1598322869
Name:HAFER, THOMAS P (PT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:P
Last Name:HAFER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1872 CONCORDIA LAKE CIR UNIT 209
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-9049
Mailing Address - Country:US
Mailing Address - Phone:239-246-7623
Mailing Address - Fax:
Practice Address - Street 1:58 NICHOLAS PKWY W #105
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991
Practice Address - Country:US
Practice Address - Phone:305-570-1666
Practice Address - Fax:239-599-4746
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT6139225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT6139OtherMEDICAL LICENSE